Two Florida hospitals now charge extra for non-emergency ER visits

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    two florida hospitals now charge extra for non-emergency er visits

    in mid-november, orange park medical center became the second northeast florida emergency room in recent months to ask the least sick of its patients to turn elsewhere for care or face a $100 fee. memorial hospital in jacksonville started the policy in august. both facilities are operated by hospital corporation of america.
    florida times-union, nov. 30, 2006
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  3. by   fiestynurse
    My HMO charges $100 for all ER visits, emergent or non-emergent.
  4. by   BSNtobe2009
    I think that is terrible and will cause some of the borderline poor (not poor enough to receive medicaid, but poor enough to where they can't pay their bills) to take unnecessary risks of not going when they probably should.

    As someone who has to go to the ER due to migraines a couple of times a year that my medication doesn't even ease the pain, I wonder if I would be charged because it's not a life-threatening emergency...after all, it's pretty hard to die from pain.
  5. by   RunnerRN
    Interesting idea....I think it would be really great for those repeat non-emergent people, but probably not the best way to solve overcrowding. Again, how to determine emergent? If my child were up screaming at 11pm and tugging at her ear, and Tylenol/Motrin wasn't helping, I'd be off to the ER for the abx. It may not help right away, but that's about 12 hours faster that the meds would be in.
    Sounds like a PR stunt that they will probably never collect on....
  6. by   skipaway
    Most, not all, who use the ER for non-emergencies do not have a primary care physician or insurance. So, how will the hospital collect their extra money. I think it's a scare tactic to make people think again before going. But I think they'll still use the ER.
  7. by   RazorbackRN
    Quote from fiestynurse
    My HMO charges $100 for all ER visits, emergent or non-emergent.

    I think this is an additional 100.00 fee. Not including copays, other charges, etc.
  8. by   hfdguy
    I am an EMT and in LPN school (due to graduate in Jan!).. I just have one thing to say:

    Shame on all of you who support this... you should be ashamed!

    In Connecticut, its a law that anyone who feels the need can go to an emergency room.

    What they are asking the average person in Florida to do is diagnose their illness and determine if they are 'sick enough' to go to the Emergency Room. That is absolutely against everything we have ever been taught in medicine.

    I hope you all remember that the most important thing about being a nurse is to be an advocate for your patient - you are the one with the knowledge, the average person has no clue, and trusts us to do what we can to help them.

    I hope two things happen: One, that everyone in Florida in healthcare write their representatives to have this outlawed, and two, that everyone charged in this manner sue the two hospitals as a class action, stating that the patient has a reasonable expectation of treatment and that they are not equiped to diagnose whether certain signs and symptoms are 'true' emergencies or not.

    How many CVA patients wake up with just a headache? What are the major signs and symptoms of a MI? AAA? Would we consider 'diffuse pain, lethergy, flu like symptoms' to be minor or indicitive of a serious life threatening condition? I know ERs are overcrowded. Most hospitals in CT now have primary care clinics associated with the ER so those deemed non-emergent can still be seen. But I also know that they have sent people to the clinic with a 'non-life threatening' condition, only to find out they are minutes away from a catastrophic event.
  9. by   Shamira Aizza
    This is a perfectly reasonable and appropriate policy.

    The emergency room should not be used for primary care.

    EMTALA defines "pain" as an emergency, so these hospitals cannot turn away patients with complaints of a headache. MI patients with atypical symptoms will not be in greater risk because of $100; if a provider is going to improperly triage someone with an MI, a fee will not make a difference.

    EMTALA always seems to be applied in a manner ONLY for the benefit of the patient while hospitals extend themselves routinely far above and beyond what is required of EMTALA to accomodate their patients.

    It is time for the emergency rooms to focus on 'emergencies' and apply the allowances of EMTALA to better perform their primary purpose.
  10. by   daisey_may
    Is there anything they have that would be considered emergency and non-emergency? There is a lot of grey area that makes me nervous.

    I just hope that there isn't an "accident" that will make this not be allowed any longer... I mean, remember that one article about the lady who had had a heart attack but was showing vague symptoms and it was ruled murder when the triage nurse didn't think she was in serious condition?

    I'm surprised that this was passed. I agree that something should be done about the non-emergent cases the E.R. sees, but I don't think the answer is to make the visit more expensive. It's a complex problem and this seems like a gloss-over solution.
  11. by   hfdguy
    The last patient I brought to the Emergency Room by ambulance was someone complaining of 'stomach pain'... very vague, no temp, no other s/s...

    Guess what... she died in the ER about 15 minutes after I got her there due to a AAA that ruptured in the ER.

    People take s/s too lightly... as nurses we are supposed to be advocates for healthcare.. I reject your thought that 'the policy is valid'... I would never want to live in florida if that is the policy and would like to see all the people who support that policy be brought before a nursing board to have their licenses revoked for a complete failure to protect their patients.
  12. by   Shamira Aizza
    I'm not following the point of the story about the person with stomach pain. She didn't die of a failure to pay a $100 fee.

    She also had symptoms (pain) that required evaluation and emergency care under EMTALA no matter what kind of fee would've been required.

    And a patient who ruptured 15 minutes after arrival to the hospital likely would not have survived unless they ruptured on the O.R. table in a tertiary care facility.

    This fee will in no way affect the provision of emergency care to patients who are truly suffering an emergency. EMTALA requires that any patient who comes to the ED deserves evaluation to determine if they have an emergency. This evaluation can be done by an RN as long as it's done according to hospital policy. If no emergency is determined to exist, the hospital has the right to turn people away...(this is according to federal law), or has the right to treat them, or has the right to charge them $100 for non-emergent treatment and turn them away if they won't pay.

    You could criticize the facilities or the nurses, but this is law, and it's a reasonable law. There are far more protections in this law for patients than there are allowances for hospitals, and the allowances are all designed to serve the best interests of EMERGENCY patients seeking treatment in the EMERGENCY room.

    I'd be pleased to stand before the nursing board in any of the states/districts where I hold a license; the boards of nursing cannot revoke the license of a nurse who conducts her/himself within the restrictions and allowances of law. And the referral of a non-emergent patient to another primary care provider is not a failure to protect the patient. The policy of charging a non-emergent patient for non-emergent care in an emergency room is not a failure to protect a patient.

    As far as 'grey areas,' hospitals will always strive avoide litigation when it comes to determining if a patient is experiencing an emergency or not, meaning, they will usually treat someone that cannot be effectively ruled out as being non-emergent. With the volume of patients seeking primary care in emergency rooms, effectively overloading the providers and resources, it will inevitably happen that some will fall through the cracks, but that is just as much the fault of the abusers as the providers.

    More than 75% of emergency visits are non-emergent. This is a problem, and hospitals are obligated to protect their emergent patients by encouraging their non-emergent patients to seek other venues. Hospital emergency departments are at an unique disadvantage because they are the only piece of our health care system that is mandated to evaluate patients. There are no laws requiring cardiologists to accept cardiac patients or family practitioners to accept general medical patients. They can simply shut the door and say no...which of course they won't do if they are offered compensation.

    If any kind of practitioner can refuse a patient...even a critically ill patient, then emergency departments should exercize their already-granted privilege of either refusing or charging non-emergent patients for services.

    I'm not sure why this doesn't make sense to anyone who has seen the routine chaos of modern-day emergency departments who could use this money to expand their facilities to accomodate these patients.
    Last edit by Shamira Aizza on Dec 8, '06
  13. by   hfdguy
    First, I want to say thank you for this stimulating thread... I am really enjoying this banter...

    I will never agree that this law is appropriate, as long as there is a disparity based on a persons ability to pay.

    Apparently what this allows is for people to be treated in an emergency room for non-emergent problems if they have the extra 100 bucks

    i still say joe citizen should not fear that they will be charged extra in order to seek help...

    Cardiologists and others are specialists; emergency rooms are portals into the healthcare system

    And I believe its reckless to punish people who may not have the ability to pay and make them feel less important to the healthcare system - and make them feel like they shouldn't bother us unless its something 'important'..
  14. by   nursejohio
    I'm hoping against hope something similar comes my way! I don't work in the ER, but I talk to enough nurses who do to know how abused it is. People come in at all hours of the night for a rash they've had for months, MONTHS! How is that an emergency? People call 911 for things any 10 yr old can tell you aren't serious, and certainly not requiring lights & sirens. Medics respond and are required to transport a primip who has had 3 ctx rated 2/10, they take pts to the ER with hangnails. Meanwhile, last week my coworker did CPR on an MVA for 40 minutes waiting for the squad to respond. He had a pulse and shallow resp when she first saw him, by the time EMTs arrived, he had no signs of life and blown pupils. He was 20 years old. Maybe having a faster response would have made a difference, maybe not. All she knows for sure is that he was technically alive when she first saw him and despite her best efforts, she watched him die over the next 40 minutes.

    I know that this bill may not be the best or most effective solution, but something's gotta be done to get the message across that the ER is not a substitute for routine care, either at a PCP or a clinic. The medics and ER are finite, limited resources being taken away from the people who need them by the BS and it has to stop!